Norwich Sub-Acute and Nursing

In the surveyor’s words

From the most serious findings on record at Norwich Sub-Acute and Nursing, in the surveyor’s own words.

• Actual harm, isolatedF689Jun 4, 2026

  Based on review of the clinical record, facility documentation/policies, and interviews, for one (1) of three (3) sampled residents (Resident #1) who required assistance with Activities of Daily Living (ADL's), the facility failed to ensure safe bed level care for a cognitively impaired resident who required the assistance of two staff for bed mobility. Specifically, staff performed a one person turn using an unsafe technique, which resulted in the resident sliding from the bed and sustaining an acute fracture of the right tibia. […]

• Actual harm, isolatedF689Oct 15, 2025

  Based on clinical record review, facility documentation review, facility policy review, and interviews for one of three residents (Resident #1) reviewed for falls, the facility failed to provide adequate supervision for a resident identified at risk for falls, to prevent a fall with injury. The failure resulted in a resident fall with laceration that required seven (7) stitches. The findings include: Resident #1 was admitted to the facility with diagnoses that included Alzheimer's disease, dementia, anxiety, generalized muscle weakness, and depression. The quarterly Minimum Data Set (MDS) dated [DATE] identified Resident #1 had a Brief Interview for Mental Status (BIMS) score of 7 that indicated severe cognitive impairment, and required staff assistance for transfers. […]

• Actual harm, isolatedF689Jul 30, 2025

  Based on clinical record review, facility documentation review, and interviews for one sampled resident (Resident #1) reviewed for accidents, the facility failed to ensure the resident was transferred in accordance with physician orders and the plan of care to prevent a fall with injury. The failure resulted in an acute mildly displaced fracture of the distal aspect of the fibula. The findings include: Resident #1's diagnoses included deep vein thrombosis (blood clot) of the left lower extremity and anxiety. Physician orders dated 6/6/2025 directed mobility status was an assist of two persons with rolling walker, stand pivot only for transfers, and ambulation with therapy only. Nursing admission note dated 6/6/2025 identified Resident #1 was alert and oriented. […]

• Actual harm, isolatedF689Jun 9, 2025

  Based on review of the clinical record, facility documentation, facility policy and interviews for one (1) of three (3) residents (Resident #1) reviewed for falls, the facility failed to ensure the resident was supervised outside of the facility leading to a fall with injury. The findings include: Resident #1's diagnoses included Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), atrial fibrillation (irregular heartbeat), anxiety disorder and personality disorder. The annual Minimum Data Set (MDS) assessment dated [DATE] identified Resident #1 had intact cognition (Brief Interview for Mental Status (BIMS) of 13), required substantial assistance for bed mobility and was dependent on staff for transfers. […]

• No harm, potential for more than minimal, patternF812Mar 22, 2023

  Based on observation, review of facility policy, and staff interviews, during a tour of the kitchen, the facility failed to store food according to professional standards. The findings include: Observation in the Dietary Department with the Food Service Manager on 3/15/23 at 9:50 AM identified the following items found in the walk- in refrigerator: 1.French dressing 1 Gal- noted to be open and with a received date of 9/15/22. The container lacked opened and expiration dates. 2. [NAME] Italian 1 Gal- noted to be open with approximately 1/8th of the contents missing, and with a received date of 3/9/23. The container lacked opened and expiration dates. 3. Sweet Relish- noted to be open with 1/2 of the contents missing, and with a received date of 2/10/23. […]